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Bloomington docs still feuding with Anthem

September 10, 2012

A large physician practice in Bloomington remains at an impasse with Anthem Blue Cross and Blue Shield of Indiana less than two months before their contract is set to expire.

Premier Healthcare, which has about 70 physicians, accused the health insurer Anthem and its parent company WellPoint Inc. of generating large profits at doctors’ expense.

“Despite nearly $3 billion in annual profits, Anthem’s proposed new contract includes insufficient reimbursement rates,” wrote Dr. Wesley Ratliff, Premier’s president, and Dr. Lawrence Rink, Premier’s chairman, in a July letter to patients. “In an environment of physician and nurse shortages, as well as rapid advances in treatments and technologies, reimbursement rates are the key to establishing and maintaining a high-quality health care system.”

The doctors could say the same to just about every health plan these days. Reimbursement from government programs such as Medicare and Medicaid has been flat or down for doctors in many specialties, and trends suggest no substantial increases anytime soon.

Anthem spokesman Tony Felts said Premier’s request for double-digit increases in reimbursement rate was “not acceptable.”

“What that means is millions of dollars out of the pockets of our self-insured clients in the Bloomington area,” Felts said. “We can’t accept that.”

Indianapolis-based WellPoint in January promised to pay primary care physicians more or create programs where they have the chance to earn bonus payments. But Anthem officials are just beginning to talk to Indiana doctors about that initiative, Felts said, so it has yet to affect doctors’ pay.

According to its website, Premier has 18 primary care physicians, as well as 14 nurse practitioners who also deliver primary care.

Premier’s contract with Anthem is set to expire Nov. 1. After that date, Premier would no longer be obligated to give sizable discounts to Anthem customers.

Felts said there has been little discussion between the two sides since Premier notified Anthem that it would terminate its contract—a formal step required to open negotiations on a new deal. Calls to Premier executives were not returned.

The two parties have been here before. In late 2007, Premier, then known as Internal Medicine Associates, entered a bitter public battle against Anthem over its reimbursement rates. But the two sides settled at the last minute, with Anthem agreeing to reimbursement increases only if Premier scored well on quality metrics.

Few physician practices even attempt to negotiate with Anthem, which holds a commanding market share around Indiana, especially in the most lucrative employer-sponsored and individual markets. Anthem and other units of WellPoint cover more than 50 percent of such customers in the Indianapolis area, according to market research firm HealthLeaders-InterStudy.

In Bloomington, however, WellPoint has typically covered only about one-third of the commercial market.

 

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